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In fact, cobalamin deficiency is a common cause of metabolic encephalopathy, one of a number of forms of encephalopathy associated with a primary disease (such as FIP) that causes interference with normal brain function and blood-brain barrier mechanisms

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These authors also state that exercise and heat can increase swelling and pain in the lipedematous areas

doi: 10.1634/theoncologist.2018- 115 GiommoniEGiorgioneRPaderiAPellegriniEGambaleEMariniAet al